Legacy Healthcare Group

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

LEGACY HEALTHCARE GROUP

Practice address

5230 W Moonlight Mine Rd
Pocatello, ID 83201-9013

Phone

(954) 548-7312

Fax

(954) 548-7312

NPI assigned

Aug 28, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Everton Anthony Boothe, PMHNP-BC

Title

Owner

Phone

(954) 548-7312

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1787875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787875200000",
    "number": "1841108347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 W FLAGLER ST STE 900",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331301807",
            "telephone_number": "954-548-7312",
            "fax_number": "954-548-7312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5230 W MOONLIGHT MINE RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832019013",
            "telephone_number": "954-548-7312",
            "fax_number": "954-548-7312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-28",
        "last_updated": "2026-08-28",
        "certification_date": "2026-08-28",
        "status": "A",
        "authorized_official_last_name": "BOOTHE",
        "authorized_official_first_name": "EVERTON",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-548-7312",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Brendon Lee
• Robert C. Lee, D.C
• Wendy Kay Lee, M.S. CCC-SLP
• Yaeeun Lee, M.S.
• Luc Day Leech, OTR/L
• Lacy Lehman, LCSW
• Braeden Leiby, MD
• Kimberly Leishman, LPC,
• Benjamin Doran Lemmon
• Alexander Lemon

• Psychiatric/Mental Health Nurse Practitioner in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Psychiatric/Mental Health Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.